Pictured: An animation of immune cells overreacting due to a coronavirus infection from the video The Coronavirus Explained on YouTube HERE.
by Kimberly Rivers
On Tuesday, April 20, the Ventura County Board of Supervisors received an update from Barry Zimmerman, chief of the Ventura County Health Care Agency, on the county’s coronavirus testing capacity and goals.
“Capacity and implementation are different things,” said Zimmerman. He said the county is moving toward its goal of having the capability, across all hospitals, facilities and private labs, to increase capacity to perform 2,400 tests each week, up from the current average of about 1,600 a week, according to Zimmerman.
The test he is referring to is called a PCR or polymerase chain reaction test, which allows the lab to replicate DNA found in a small sample, taken most commonly by nasal swab, in order to have enough DNA to test for the virus.
It’s an important test that “allows us to know if you have active virus. But there are a lot of false negative and false positive tests,” said Dr. Stanley Frochtzwajg, chief medical officer at Community Memorial Health Care System in Ventura.
Frochtzwajg spoke at length with the VCReporter on April 20 about what the science currently tells us about the novel coronavirus and COVID-19, and the implications for public policy.
The limitations of testing
“We don’t really know what the testing [result] means.” He said one patient tested multiple times for coronavirus had results that came back positive, then negative. The lack of consistency makes it “difficult to know how valid the testing is,” making testing less useful overall.
Zimmerman also told the supervisors that the county is working to obtain antibody tests, which would be part of efforts to once again allow elective surgeries, currently cancelled due to the coronavirus.
“Everybody wants the antibody test. The prevailing feeling is that once we can tell who was exposed and now has antibodies, that theoretically will confer an immunity,” said Frochtzwajg, but he added, “I have concerns that we are starting to talk about opening things up . . . allowing elective surgery. We don’t know enough to make an optimal decision.”
“We don’t really know what the antibody test indicates,” he explained. “Does it mean that they cannot truly infect others? Are they truly immune? How long are they immune? Do they shed the virus? That’s what is so frustrating . . . We have these great hopes. But it’s more hopeful than knowledge.”
The presence of antibodies in a person’s blood generally means that person cannot be re-infected with the virus, and that they won’t infect anyone else. But from the start, this novel virus has revealed that it is unique and what we don’t know about it still far exceeds what we do know.
“This is a first time for us. We’ve never experienced this and don’t really understand it. It’s important to understand a virus is not necessarily a virus.”
Frochtzwajg meant that while we call this a virus and prescribe certain attributes to it, that does not mean that it actually behaves like any other virus humans have experience with. He referred to HIV, the virus that causes AIDS, and how that virus behaved unlike any other virus known at the time. “It was an entity unto itself, a virus that acted very differently.” The coronavirus is unique in that way, too.
In Frochtzwajg’s view, “the antibody testing is really problematic . . . there is evidence that people who have antibodies seem to shed the virus.” Meaning they can still infect other people.
“The problem with the antibodies [of this particular virus] is that we don’t know if they actually prevent reinfection. We don’t know if the antibodies are functional [in giving immunity] for weeks, months or years.”
The World Health Organization (WHO) stated on April 15 that “there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.” As communities around the world (including Ventura County) decide how to open up, being able to know who has had the virus and who is immune will be key.
Frochtzwajg emphasized another consideration is the way age impacts immunity conveyed by antibodies. Antibodies in an “elderly person [may] not carry the same value as one who is younger would get from those antibodies.”
Treatments and prevention
“I don’t know that we [the medical community] have been fully transparent and honest in describing the limitations” of the treatments available, pondered Frochtzwajg.
“In reference to medications — like hydroxychloroquine and the use of steroids, the use of a vaccine, everything is completely unproven and untested,” he said. “You hear so much information and so much talk. People are trying to get these medications and take them. People are grasping onto straws, that is a problem.”
Last week, Ventura County Public Health touted the use of convalescent plasma as a positive step forward to meeting one of the six points Gov. Gavin Newsom listed as necessary for reopening up communities. The county has a system set up for those who have recovered from the virus and COVID-19 to register to become plasma donors.
Frochtzwajg called this a “relatively unproven process as well. Unfortunately, the one individual who was treated [with plasma] last week passed away.” He says the drive to use unproven treatments “is problematic, but it’s common for people to grasp at straws when they are drowning.”
For the most seriously ill patients with COVID-19, the respiratory illness caused by the coronavirus, ventilators are a treatment of last resort.
“Anytime you put a tube in a person’s throat, into their lungs and take over their breathing [you create] a conduit going both ways, air and infection going in, pressure going in,” Frochtzwajg explained, saying that risks include popped or collapsed lungs. “It is unusual to use ventilators except in very demanding and reasonable ways. There is not a desire to intubate and ventilate a patient.” A patient on a ventilator makes more work for hospital staff, and “it’s more dangerous…ventilators are used as a last resort.”
Now the treatment protocol has shifted and hospitals are finding that they “might be able to prevent” the need to ventilate “by placing patients in a prone position,” laying them on their bellies instead of their backs. He said they are seeing this help patients at CMH.
As far as a vaccine goes, Frochtzwajg said that it “is well in the future. There are currently 60 viral mutants we are able to identify of the initial virus. A vaccine may work against one, but not necessarily against all of them.”
It is estimated that a vaccine won’t be ready, at the very earliest, until 2021. Thus, some researchers are looking at other options.
The VCReporter previously reported on a local lab, ProgenaBiome, which submitted clinical trials applications earlier this month. (1) Two of those trials are underway. One will examine the gut biome of 250 people who have tested positive for the disease to determine if differences in the digestive system may hold a key to preventing infection; it is currently recruiting participants. A second trial will study whether hydroxychloroquine, Vitamin C, Vitamin D and zinc (used individually) have any ability to prevent or treat the symptoms of COVID-19.
Immune response and the cytokine storm
Cytokines are proteins created by various systems in the body, including the immune system, to help direct the body’s response to foreign bodies. Cytokines play a major role in inflammation, for example. They also appear to be involved in the most deadly COVID-19 infections.
Frochtzwajg joined the voices of doctors around the globe pointing to a “cytokine storm” occurring in the bodies of people battling COVID-19. “The people we lose with COVID-19 . . . it is not the infection that causes them to die. Most of these people die because their own body’s immune system attacks them . . . Some people have an accentuated cytokine release and reaction that can cause them to be overwhelmed.”
“When we get allergies, our body’s immune system senses the foreign pollens and attempts to protect us,” Frochtzwajg explained. “But our bodies get confused and some have bad reactions . . . an accentuated cytokine immune reaction, instead of helping us, it harms us.”
Examples of overactive immune reactions include hay fever, hives and Guillain-Barré syndrome, which generally occurs after an infection and causes the immune system to attack the body’s nervous system. In severe cases, this can lead to paralysis and death.
Frochtzwajg pointed toward other factors — stress, tobacco and alcohol use, obesity — that affect the strength of our immune system and its ability to protect us from illness.
He admitted that there is also “the genetic component . . . Immune responses vary based on genetic profile,” and that the medical community generally “doesn’t have a good handle” on how genetics and factors such as stress synergize together to impact how our immune system behaves, and what leads to an overreaction.
“There is so much we don’t know, very little that we do know.”
Questions about mortality rate
“If you look at the people who have passed away with the virus, most are elderly and those who are not elderly have comorbidity conditions . . . that predispose them to dying from this virus,” noted Frochtzwajg.
He said we haven’t tested enough people overall to know the true mortality rate of the virus. At this point, many are likely to have or have had the virus and not know it. Those people are not part of the equation yet.
“Upwards of 50 percent don’t get symptoms, and are not tested.” Initially the thinking was that the coronavirus was 10 times as lethal as the common flu. “Well, maybe that is wrong. It might be the exact same lethality as the common flu.”
A gradual drop in oxygen levels appears to be another aspect of the illness.
“COVID-19 patients seem less mentally affected by the drop in oxygen. We see something similar in emphysema patients,” Frochtzwajg said.
Medical workers have described a phenomenon whereby a person seems fine, then suddenly requires oxygen — as if their body has been adapting, then a threshold is reached beyond which the body can cope.
“Follow the science”
As the county grapples to determine a path forward, weighing public safety and economic concerns, it is paramount that we acknowledge all aspects of the coronavirus: what we know, what we don’t, the limits of our knowledge, the capabilities and inadequacies of the public health response. Despite the many questions that so far remain unanswered, Frochtzwajg is clear on one thing.
“It is so important to follow the science,” he emphasized.
Video recommended by Dr. Frochstzwajg about the virus and cytokine storm: https://www.youtube.com/watch?v=BtN-goy9VOY&feature=youtu.be.
- “Trying to save humanity: Dr. Sabine Hazan and ProgenBiome are working tirelessly to combat COVID-19,” Kimberly Rivers, VCReporter, March 25, 2020